Orthopedic surgical system including surgical access systems, distraction systems, and methods of using same

ABSTRACT

A surgical access system includes a connector including an arm having first and second end portions, a coupling element having a body portion defining a cavity therein, and a gear assembly. The gear assembly includes a first gear disposed within the cavity of the coupling element and a second gear non-rotatably disposed at the first end portion of the arm. The first and second gears are meshingly engaged with each other such that rotation of the first gear results in rotation of the second gear which, in turn, causes the arm to pivot with respect to the coupling element.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/234,174, filed on Aug. 11, 2016, which claims the benefitof, and priority to, U.S. Provisional Patent Application Ser. No.62/204,384, filed on Aug. 12, 2015, and U.S. Provisional PatentApplication Ser. No. 62/204,386, filed on Aug. 12, 2015, the entirecontents of each of which are hereby incorporated herein by reference.

TECHNICAL FIELD

The present disclosure relates generally to orthopedic surgical systems,and more particularly, to surgical access systems for separating tissuein a surgical field to increase visualization of the surgical field andsurgical distraction systems for separating adjacent vertebral bodies,and methods of using the same.

BACKGROUND

The human spine includes thirty-three vertebrae. The vertebrae interlockwith one another to form a spinal column. Each vertebra has acylindrical bony body (vertebral body), two pedicles extending from thevertebral body, a lamina extending from the pedicles, two wing-likeprojections extending from the pedicles, a spinous process extendingfrom the lamina, a pars interarticularis, two superior facets extendingfrom the pedicles, and two inferior facets extending from the lamina.The vertebrae are separated and cushioned by thin pads of tough,resilient fiber known as intervertebral discs. Intervertebral discsprovide flexibility to the spine and act as shock absorbers duringactivity. A small opening (foramen) located between each vertebra allowspassage of nerves. When the vertebrae are properly aligned, the nervespass through without a problem. However, when the vertebrae aremisaligned or a constriction is formed in the spinal canal, the nervesget compressed and may cause back pain, leg pain, or other neurologicaldisorders.

Disease, the effects of aging, or physical trauma resulting in damage tothe spine has been treated in many instances by fixation orstabilization of the effected vertebra. A wide variety of spinalfixation apparatuses have been employed in surgical procedures forcorrecting spinal injuries and the effects of spinal diseases.

Disorders of the spine that may cause misalignment of the vertebrae orconstriction of the spinal canal include spinal injuries, infections,tumor formation, herniation of the intervertebral discs (i.e., slippageor protrusion), arthritic disorders, and scoliosis. In these pathologiccircumstances, surgery may be tried to either decompress the neuralelements and/or fuse adjacent vertebral segments. Decompression mayinvolve laminectomy, discectomy, or corpectomy. Laminectomy involves theremoval of part of the lamina, i.e., the bony roof of the spinal canal.Discectomy involves removal of the intervertebral discs. Corpectomyinvolves removal of the vertebral body as well as the adjacentintervertebral discs.

The time-honored method of addressing the issues of neural irritationand instability resulting from severe disc damage has largely focused onremoval of the damaged disc and fusing the adjacent vertebral elementstogether. Removal of the disc relieves the mechanical and chemicalirritation of neural elements, while osseous union (bone knitting)solves the problem of instability.

After a partial or complete discectomy, the normally occupied spacebetween adjacent vertebral bodies is subject to collapse and/ormisalignment due to the absence of all or a part of the intervertebraldisc. In such situations, the physician may insert one or moreprosthetic spacers between the affected vertebrae to maintain normaldisc spacing and/or the normal amount of lordosis in the affectedregion.

Typically, a prosthetic implant is inserted between the adjacentvertebrae and may include pathways that permit bone growth between theadjacent vertebrae until they are fused together. As is typical, theintervertebral spaces are accessed either anteriorly or posteriorly. Itwould be desirable to access the intervertebral spaces via an approachthat provides greater access to the surgical area while applying theleast amount of stress to the surrounding tissue.

Additionally, one of the challenges during surgery is to ensure that thevertebral bodies can maintain parallel distraction so as not to move thespine out of alignment.

Therefore, a need exists for systems and/or devices used in spinalsurgery that provides greater access and visualization of a surgicalarea while applying the least amount of stress to the surrounding tissueand/or maintains alignment and spacing of the vertebral bodies and rigidattachment to the vertebral bodies.

SUMMARY

In accordance with an aspect of the present disclosure, a surgicalaccess system includes a beam, a first support operably coupled to thebeam, and a first connector operably connected to the first support. Thefirst connector includes an arm including a first end portion and asecond end portion, a coupling element including a body portion defininga cavity therein, and a gear assembly. The gear assembly includes afirst gear disposed within the cavity of the coupling element and asecond gear non-rotatably disposed at the first end portion of the arm.The first and second gears are meshingly engaged with each other suchthat rotation of the first gear results in rotation of the second gearwhich, in turn, causes the arm to pivot with respect to the couplingelement.

In embodiments, the first gear includes a head portion and an elongatedthreaded body portion terminating at a distal end. An opening of thefirst cavity may be defined in a front surface of the coupling element,and the head portion of the first gear may be accessible through theopening for rotating the first gear. In some embodiments, the first gearis a worm screw.

In embodiments, the second gear includes a rounded body portion having atoothed outer surface. In some embodiments, the second gear is a wormwheel.

The second end portion of the arm may include a cavity having areceiving element disposed therein. The receiving element may include anengaging portion movable between a locked state and an unlocked state.In some embodiments, the surgical access system further includes a firstretractor blade having a planar portion including a protruding portionhaving a grooved defined therein, and a blade portion extending along adifferent plane than the planar portion. The protruding portion isreleasably engaged with the engaging portion of the receiving element.

In embodiments, the surgical access device further includes a secondsupport operably coupled to the beam, a second connector operablyconnected to the second support, and a second retractor blade releasablyengaged to the second connector.

In accordance with another aspect of the present disclosure, a surgicalaccess system includes a first support, a second support, a cross barinterconnecting the first and second supports, and a first connectoroperably connected to the cross bar. The first connector includes an armincluding a first end portion and a second end portion, a couplingelement including a body portion defining a cavity therein, and a gearassembly. The gear assembly includes a first gear disposed within thecavity of the coupling element and a second gear non-rotatably disposedat the first end portion of the arm. The first and second gears aremeshingly engaged with each other such that rotation of the first gearresults in rotation of the second gear which, in turn, causes the arm topivot with respect to the coupling element.

In embodiments, the first gear includes a head portion, an elongatedthreaded body portion, and a tail portion. A first opening of the cavitymay be defined in a front surface of the coupling element, and the headportion of the first gear may be accessible through the first openingfor rotating the first gear. In some embodiments, the first gear is aworm screw.

In embodiments, the second gear includes a rounded body portion having atoothed outer surface. In some embodiments, the second gear is a wormwheel. The second gear may be integrally formed on the first end portionof the arm.

The second end portion of the arm may include a cavity having areceiving element disposed therein. The receiving element may include anengaging portion movable between a locked state and an unlocked state.In some embodiments, the surgical access system further includes a firstretractor blade having a planar portion including a protruding portionhaving a grooved defined therein, and a blade portion extending along adifferent plane than the planar portion. The protruding portion isreleasably engaged with the engaging portion of the receiving element.

In embodiments, the surgical access device includes a second connectoroperably connected to the cross bar.

In accordance with an aspect of the present disclosure, a surgicalaccess system includes a first connector including an arm, a couplingelement, a rod, and a ridged slider. The arm includes first and secondnotched sections disposed in opposed lateral sides of the arm. Thecoupling element includes a body section defining an openingtherethrough, and opposed tabs protruding from the body section that areconfigured to receive the second notched section of the arm therebetweensuch that the arm is pivotably coupled to the coupling element. The rodincludes a shaft having a plurality of angled grooves defined partiallyalong a length thereof. The rod extends through the opening of thecoupling element and the first notched section of the arm. The ridgedslider includes a first surface having a plurality of ridges extendingalong a partial length thereof. The ridged slider extends through thecoupling element with the plurality of ridges operably engaged with theplurality of angled grooves of the rod.

The first notched section of the arm of the first connector may includea connecting element and the rod may include a circumferential grooveengaged with the connecting element.

In embodiments, the first connector has a closed position in which thearm is adjacent to the coupling element, and an open position in whichthe arm is angled with respect to the coupling element.

The arm of the first connector may include a cavity having a receivingelement disposed therein. The receiving element may include an engagingportion movable between a locked state and an unlocked state.

In embodiments, the surgical access system further includes a firstretractor blade having a planar portion including a protruding portionhaving a grooved defined therein, and a blade portion. The planar andblade portions extend along different planes. In some embodiments, theprotruding portion of the first retractor blade is releasably engagedwith the engaging portion of the receiving element.

The surgical access device may further include a second connector and asecond retractor blade. The surgical access device may further includefirst and second supports, and a beam. The first retractor blade may becoupled to the first support and the second retractor blade may becoupled to the second support. The first support may be fixed to thebeam and the second support may be slidably mounted on the beam.

In embodiments, the surgical access device further includes an extensiondevice having a first extension arm pivotably coupled to a secondextension arm. The second extension arm includes a protruding portionhaving a groove defined therein. In some embodiments, the protrudingportion of the extension device is releasably engaged with the engagingportion of the receiving element. In certain embodiments, the extensiondevice includes a channel releasably engaged with the protruding portionof the first retractor blade.

In accordance with another aspect of the present disclosure, a surgicaldistraction system includes a distractor device including first andsecond elongated members pivotably coupled together. Each of the firstand second elongated members includes a flat portion disposed on alateral side thereof. The flat portions are substantially parallel toeach other and in abutting relationship when the distractor device is ina closed position, and the flat portions are substantially parallel toeach other and laterally spaced apart when in an open position.

In embodiments, each of the first and second elongated members of thedistractor device includes a partial lumen extending partially along alength thereof substantially perpendicularly from the flat portion.

The surgical distraction system may further include a plurality of pinsreleasably engaged with the partial lumens of the first and secondelongated members of the distractor device. Each pin of the plurality ofpins may include at least one protrusion and the partial lumens mayinclude at least one detent configured to receive the at least oneprotrusion.

In embodiments, the distractor device includes a handle including abiasing mechanism configured to bias the distractor device in the closedposition.

In accordance with an aspect of the present disclosure, a method ofcreating separation between adjacent vertebral bodies includes insertingfirst and second pins into adjacent vertebral bodies, securing first andsecond elongated members of a distractor device to the first and secondpins, the first and second elongated members pivotably coupled together,and each of the first and second elongated members including a flatportion disposed on a lateral side thereof, the flat portions beingsubstantially parallel to each other and in an abutting relationshipwhen the distractor device is in a closed position, and the flatportions being substantially parallel to each other and laterally spacedapart when the distractor device is in an open position, andmanipulating a handle of the distractor device to move the distractordevice to the open position to apply a distraction force to the adjacentvertebral bodies.

In embodiments, securing the first and second elongated members of thedistractor device to the first and second pins includes positioning thedistractor device between the first and second pins, and manipulatingthe handle of the distractor device to move the first and secondelongated members of the distractor device into contact with the firstand second pins to releasably secure the first and second elongatedmembers to the first and second pins.

The method may further include inserting first and second retractorblades of a surgical access system into an opening in a patient, andmoving at least one of the first and second retractor blades to increasea size of the opening.

In embodiments, the method further includes manipulating the handle ofthe distractor device to move the distractor device to the closedposition to remove the distraction force, and removing the distractordevice and the first and second pins from the adjacent vertebral bodies.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosureand, together with a general description of the disclosure given above,and the detailed description of the embodiments given below, serve toexplain the principles of the disclosure, wherein:

FIG. 1A is a perspective view of a connector in accordance with anembodiment of the present disclosure;

FIG. 1B is an exploded view of the connector of FIG. 1A;

FIG. 2A is a front view of the connector of FIG. 1A in a straight orclosed position;

FIG. 2B is a cross-sectional view of the connector of FIG. 2A, takenalong line 2B-2B of FIG. 2A;

FIG. 3A is a front view of the connector of FIG. 1A in an angled or openposition;

FIG. 3B is a cross-sectional view of the connector of FIG. 3A, takenalong line 3B-3B of FIG. 3A;

FIG. 4A is a front view of a straight retractor blade in accordance withan embodiment of the present disclosure;

FIG. 4B is a side view of the straight retractor blade of FIG. 4A;

FIG. 4C is a perspective view of a tapered retractor blade in accordancewith another embodiment of the present disclosure;

FIG. 4D is a front view of the tapered retractor blade of FIG. 4C;

FIG. 4E is a side view of the tapered retractor blade of FIGS. 4C and4D;

FIG. 5A is a perspective view of an angled retractor blade in accordancewith yet another embodiment of the present disclosure;

FIG. 5B is a front view of the angled retractor blade of FIG. 5A;

FIG. 5C is a side view of the angled retractor blade of FIGS. 5A and 5B;

FIG. 5D is a front view of a straight retractor blade in accordance withanother embodiment of the present disclosure;

FIG. 5E is a side view of the straight retractor blade of FIG. 5D;

FIG. 6A is a perspective view of the arm of the connector of FIG. 1Areleasably secured to the tapered retractor blade of FIG. 4C via areceiving element in accordance with an embodiment of the presentdisclosure;

FIG. 6B is an exploded view of the arm and the receiving element of FIG.6A, with a portion of the tapered retractor blade of FIG. 4C shownseparated from the arm;

FIG. 6C is a top view of the arm of the connector and the taperedretractor blade of FIG. 4C, with the receiving element in a lockedstate;

FIG. 6D is a cross-sectional view of the arm of the connector and thetapered retractor blade of FIG. 4C, taken along line 6D-6D of FIG. 6C;

FIG. 6E is a top view of the receiving element, in a locked state, andthe tapered retractor blade of FIG. 4C, with the arm of the connectorremoved;

FIG. 6F is a cross-sectional view of the receiving element and thetapered retractor blade of FIG. 4C, taken along line 6F-6F of FIG. 6E;

FIG. 6G is a top view of the arm of the connector and the taperedretractor blade of FIG. 4C, with the receiving element in an unlockedstate;

FIG. 6H is a cross-sectional view of the arm of the connector and thetapered retractor blade of FIG. 4C, taken along line 6H-6H of FIG. 6G;

FIG. 6I is a top view of the receiving element, in an unlocked state,and the tapered retractor blade of FIG. 4C, with the arm of theconnector removed;

FIG. 6J is a cross-sectional view of the receiving element and thetapered retractor blade of FIG. 4C, taken along line 6J-6J of FIG. 6I;

FIG. 7A is a top view of a surgical access system in accordance with anembodiment of the present disclosure, with connectors in a straight orclosed position;

FIG. 7B is a top view of the surgical access system of FIG. 7A, with theconnectors in an open or angled position;

FIG. 8A is a top view of the surgical access system of FIG. 7A, withretractor blades coupled thereto;

FIG. 8B is a side view of the surgical access system of FIG. 8A;

FIG. 9A is a top view of the surgical access system of FIG. 8A, withretractor blades coupled thereto and in an angled position;

FIG. 9B is a side view of the surgical access system of FIGS. 7B and 9A;

FIG. 10A is a top view of an extension device in accordance with anembodiment of the present disclosure;

FIG. 10B is a side view of the extension device of FIG. 10A;

FIG. 10C is an exploded view of the extension device of FIGS. 10A and10B;

FIG. 11 is a top view of a surgical access system in accordance withanother embodiment of the present disclosure;

FIG. 12A is a top view of a surgical access system in accordance withyet a further embodiment of the present disclosure;

FIG. 12B is a side view of the surgical access system of FIG. 12A;

FIG. 13 is a top view of a surgical access system in accordance with analternate embodiment of the present disclosure;

FIG. 14A is a perspective view of a distractor device in accordance withan embodiment of the present disclosure;

FIG. 14B is an enlarged view of the area of detail of the distractordevice of FIG. 14A;

FIG. 15 is a front view of a pin in accordance with an embodiment of thepresent disclosure;

FIG. 16A is a front perspective view of a surgical distraction systemwith the distractor device of FIG. 14A coupled to pins of FIG. 15 inaccordance with an embodiment of the present disclosure;

FIG. 16B is an enlarged view of the area of detail of FIG. 16A showingthe pins separated from the distractor device;

FIG. 16C is a front end view of the surgical distraction system of FIG.16A;

FIG. 16D is a side view of the surgical distraction system of FIG. 16A;

FIG. 16E is an enlarged side view of the area of detail of FIG. 16Dshowing a distal portion of the surgical distraction system;

FIG. 17A is a back view of a connector in accordance with anotherembodiment of the present disclosure;

FIG. 17B is a cross-sectional view of the connector of FIG. 17A, takenalong line 17B-17B of FIG. 17A;

FIG. 17C is a side view of the connector of FIG. 17A, with partsseparated;

FIG. 18A is a top view of a surgical access system in accordance with anembodiment of the present disclosure, with connectors in a straightposition;

FIG. 18B is a side view of the surgical access system of FIG. 18A;

FIG. 19A is a top view of the surgical access system of FIGS. 18A and18B, with the connectors in an angled position;

FIG. 19B is a side view of the surgical access system of FIG. 19A;

FIG. 20A is a top view of a connector in accordance with yet anotherembodiment of the present disclosure;

FIG. 20B is a cross-sectional view of the connector of FIG. 20A, takenalong line 20B-20B of FIG. 20A;

FIG. 20C is a side view of the connector of FIGS. 20A and 20B in astraight position;

FIGS. 21A and 21B are side views of the connector of FIGS. 20A-20C inangled positions;

FIGS. 22A and 22B are side views of the connector of FIGS. 20A-20C and across bar;

FIG. 23A is a top view of a surgical access system in accordance withanother embodiment of the present disclosure, with connectors in astraight position;

FIG. 23B is a side view of the surgical access system of FIG. 23A;

FIG. 24A is a top view of the surgical access system of FIGS. 23A and23B, with one connector in an angled position; and

FIG. 24B is a side view of the surgical access system of FIG. 24A.

DETAILED DESCRIPTION

Embodiments of the present disclosure are now described in detail withreference to the drawings in which like reference numerals designateidentical or corresponding elements in each of the several views.Throughout this description, the term “proximal” refers to a portion ofa system, device, or component thereof that is closer to a clinician,and the term “distal” refers to the portion of the system, device, orcomponent thereof that is farther from the clinician.

Referring now to the drawings, FIGS. 1A and 1B illustrate a connector100 configured and adapted for a minimally invasive surgical procedureto access, for example, the thoracic or lumbar vertebrae, in accordancewith an embodiment of the present disclosure. The connector 100 issuitable for use with a retractor or surgical access system 2 (see FIG.11) as will be described in detail hereinbelow. The connector 100includes an arm 110, a coupling element 120, a rod 130, and a ridgedslider 140. The arm 110 is configured and dimensioned to receive andsupport the coupling element 120 which, in turn, is configured anddimensioned to receive and support the rod 130 and the ridged slider140.

The arm 110 extends along a longitudinal axis “X” (FIG. 6C), andincludes a first end portion 110 a and a second end portion 110 b. Thefirst end portion 110 a includes a first notched section 112 disposed ina lateral side of the arm 110 that is configured and dimensioned toreceive the rod 130, and a second notched section 114 disposed in anopposed lateral side of the arm 110 that is configured to receive a tab126 of the coupling element 120. The first notched section 112 includesa connecting element 116 that is configured and dimensioned to engage acircumferential groove 131 of the rod 130. In embodiments, theconnecting element 116 is a ridge or raised surface that extends fromand wraps around an interior wall of the first notched section 112 (seee.g., FIG. 6B), and in some embodiments, the connecting element issubstantially “U” or “C” shaped. It is contemplated that other shapes,textures, and/or configurations of the connecting element are possibleso long as the connecting element 116 can releasably engage thecircumferential groove 131 of the rod 130. The second notched section114 includes a pair of opposed openings 115 configured to receiving afixation pin 150 for securing the coupling element 120 to the arm 110.The arm 110 is rotatable about the fixation pin 150.

The second end portion 110 b of the arm 110 includes a cavity 111defined therein that is configured and dimensioned to house a receivingelement 160 (see e.g., FIG. 6B), as described in further detail below.The cavity 111 is open at a first opening 111 a defined in a proximalsurface 118 a of the arm 110, a second opening 111 b defined in a frontsurface 118 b of the arm 110, and a third opening 111 c defined in aback surface 118 c of the arm 110.

The coupling element 120 includes a body section 122 and a protrudingsection 124 integrally formed with and extending from a side surface ofthe body section 122. The body section 122 includes an opening 123extending transverse through the body 122 that is configured anddimensioned to receive the rod 130 and the ridged slider 140. Theprotruding section 124 includes a pair of opposed tabs 126 configured toreceive the second notched section 114 of the arm 110 therebetween. Eachtab of the pair of opposed tabs 126 includes an opening 127 definedtherethrough that is configured to receive the fixation pin 150 forsecuring the coupling element 120 to the arm 110, as described above.Retaining features 128 extend from a distal surface of the body section122 of the coupling element 120 for coupling with a support 180 (seee.g., FIG. 7A).

The rod 130 includes a shaft 132 that extends between a first end 130 aand a second end 130 b of the rod 130. While the rod 130 is shown assubstantially circular and having a circumference, it should beunderstood that the rod may be any shape, such as substantially squareor angled. The shaft 132 includes a plurality of angled grooves 134defined partially along a length of one side of the shaft 132. It shouldbe understood, however, that the plurality of angled grooves 134 mayextend around the circumference of the shaft 132.

The plurality of angled grooves 134 are disposed at an angle withrespect to the shaft 132 and, in embodiments, the plurality of angledgrooves 134 are disposed within a range of about 30° to about 40°. Itshould be understood that the plurality of angled grooves 134 may bedisposed at any angle so long as they are configured to engage aplurality of ridges 142 disposed on the ridged slider 140, as describedin further detail below. Additionally or alternatively, the shaft 132 ofthe rod 130 may include any textured pattern partially along its lengthand/or around its circumference so long as the textured pattern isconfigured to engage the ridged slider 140 (i.e., the shaft and theridged slider have complementary configurations).

The first end 130 a of the rod 130 includes a flattened side 136 locatedon the same side of the rod 130 as the plurality of angled grooves 134.The first end 130 a of the rod 130 has a circumference that is greaterthan the circumference of the shaft 132. The larger circumference of thefirst end 130 a aids in preventing the rod 130 from moving completelythrough the first opening 123 of the coupling element 120.

A circumferential groove 131 is defined between the second end 130 b ofthe rod 130 and the shaft 132 in longitudinally spaced relation relativeto the plurality of angled grooves 134. It should be understood that thecircumferential groove 131 may be any shape or form so long as it isconfigured to engage the connecting element 116 in the first notchedsection 112 of the arm 110, as discussed above.

The ridged slider 140 includes a first surface 140 a having a pluralityof ridges 142 extending along a partial length thereof. The plurality ofridges 142 is disposed at an angle with respect to the first surface 140a to engage the plurality of angled grooves 134 of the rod 130, asdiscussed above. The plurality of ridges 142 may be any shape or form solong as they are configured to engage the plurality of angled grooves134 of the rod 130. In embodiments, the ridged slider 140 acts as a pawlwith the plurality of angled grooves 134 of the rod 130.

The ridged slider 140 includes a beveled surface 140 b. The angle of thebeveled surface 140 b may be shallow (e.g., no bevel) or deep (e.g.,almost 90°), or any angle therebetween. The angle of the beveled surface140 b affects the ability to apply a force to the ridged slider 140 by auser.

The ridged slider 140 is connected to the coupling element 120 with atleast one connection pin 152 such that the first surface 140 a of theridged slider 140 is adjacent to the rod 130. The ridged slider 140 isoperably coupled to a biasing member 154, such as a spring, disposedbetween the ridged slider 140 and an inner surface of the couplingelement 120 to bias the ridged slider 140 towards engagement with therod 130 thereby defining a locked state.

Referring now to FIGS. 2A and 2B, the connector 100 is shown in astraight or closed position. The arm 110 is coupled to the couplingelement 120 via fixation pin 150. The rod 130 extends through theopening 123 (FIG. 1B) in the coupling element 120 and thecircumferential groove 131 of the rod 130 is engaged with the connectingelement 116 of the first notched section 112 of the arm 110. The ridgedslider 140 also extends through the opening 123 of the coupling element120 and is operatively engaged with the biasing member 154 so that theridged slider 140 is biased towards the locked state. In the lockedstate, the plurality of ridges 142 on the first surface 140 a of theridged slider 140 is engaged with the plurality of angled grooves 134 ofthe rod 130.

The arm 110 of the connector 100 can move from the straight or closedposition (FIGS. 2A and 2B) to an angled or open position, as shown inFIGS. 3A and 3B. A user applies a force to the first end 130 a of therod 130 thereby causing the plurality of angled grooves 134 to disengagefrom the plurality of ridges 142 of the ridged slider 140. Because thecircumferential groove 131 of the rod 130 is engaged with the connectingelement 116 of the arm 110, the arm 110 rotates about the fixation pin150 to the angled or open position. Once the force is removed, theplurality of ridges 142 of the ridged slider 140 engages the pluralityof angled grooves 134 of the rod 130 along a portion closer to the firstend 130 a of the rod 130 thereby retaining the connector 100 in theangled or open position. It should be noted that the rod 130 cancontinue to move upon an application of a force thereto so long as theplurality of ridges 142 of the ridged slider 140 is engaged with theplurality of angled grooves 134 of the rod 130. It should be understoodthat the rod 130 may only move in one direction due to the angle of theplurality of grooves 134 when the plurality of ridges 142 of the ridgedslider 140 are engaged with the plurality of angled grooves 134. Asdiscussed below, the rod 130 may be moved in two directions when theridged slider 140 is in an unlocked state and the plurality of ridges142 are disengaged from the plurality of angled grooves 134.

The arm 110 may also move from an angled or open position to a straightor closed position, e.g., from the angled or open position of FIGS. 3Aand 3B to the straight or closed position of FIGS. 2A and 2B. A userapplies a force to the beveled surface 140 b of the ridged slider 140which, in turn, causes the ridged slider 140 to engage the biasingmember 154 thereby moving the ridged slider 140 from a locked state toan unlocked state, and away from the rod 130. In the unlocked state, theridged slider 140 actively engages the biasing member 154 and theplurality of ridges 142 of the ridged slider 140 disengages from theplurality of angled grooves 134 of the rod 130. The arm 110 can then berotated around the fixation pin 150 to the straight or closed position.Once the force is removed from the beveled surface 140 b of the ridgedslider 140, the biasing member 154 is disengaged and the ridged slider140 returns to the locked state. Specifically, the ridged slider 140slides back towards the rod 130 so that the plurality of ridges 142engage the plurality of angled grooves 134 to retain the arm 110 in thestraight or closed position.

The cavity 111 of the arm 110 is configured and dimensioned toreleasably secure a protruding portion of a retractor blade or aprotruding portion of an extension device thereto. Exemplary retractorblades are shown in FIGS. 4A-5E, and an exemplary extension device isshown in FIGS. 10A-10C.

Referring now to FIGS. 4A and 4B, a straight retractor blade 200includes a planar portion 210 and a blade portion 212 extending, in adifferent plane, than the planar portion 210. The planar blade portions210, 212 extend along transverse planes such that the planar and bladeportions 210, 212 are substantially orthogonal to each other. The planarportion 210 is configured and dimensioned to engage the back surface 118c (FIG. 1A) of the arm 110, such as in a superposed relationship. Theplanar portion 210 includes a protruding portion 214 configured anddimensioned to extend into the cavity 111 (FIG. 1A) of the arm 110through the third opening 111 c defined in the back surface 118 c of thearm 110. As described in further detail below, the protruding portion210 includes a groove 216 configured and dimensioned to releasablyengage an engaging portion 162 (see e.g., FIG. 6D) of a receivingelement 160 of the arm 110. The blade portion 212 includes a distal end212 a having a curvature “C,” and defining a recess 213 therein.

As shown in FIGS. 4C-4E, a tapered retractor blade 201 is shown. Thetapered retractor blade 201 is substantially similar to the straightretractor blade 200 of FIGS. 4A and 4B, and includes a planar portion210 including a protruding portion 214 having a groove 216 definedtherein, and a blade portion 212′ including a distal end 212 a′ having acurvature “C,” and defining a recess 213′ therein. The blade portion212′ of the tapered retractor blade 201, however, tapers towards theplanar portion 210. While the blade portion 212′ is shown as beingangled relative to the planar portion 210, it should be understood thatthe blade portion 212′ may be substantially orthogonal to the planarportion 210 as described above with regard to the straight retractorblade 200 of FIGS. 4A and 4B.

FIGS. 5A-5C show an angled retractor blade 202 in accordance withanother embodiment of the present disclosure. The angled retractor blade202 is substantially similar the retractor blades 200, 201 describedabove with regard to FIGS. 4A-4E. The angled retractor blade 202includes a planar portion 210″ including a protruding portion 214″having a groove 216″, and a blade portion 212″ including a distal end212 a″ having a curvature “C.” The blade portion 212″ of the angledretractor blade 202 extends along a plane that is angled, but notorthogonal, with respect to the plane along which the planar portion210″ extends. Additionally, the protruding portion 214″ is offset at anangle relative to the plane of the planar portion 210″. In embodiments,the protruding portion 214″ may be disposed at a 30° with respect to theplanar portion 210″. One of ordinary skill in the art will readilyunderstand that once the protruding portion 214″ of the angled retractorblade 202 is engaged with the cavity 111 (see e.g. FIG. 1A) of an arm110, the blade portion 212″ is offset at the angle of the protrudingportion 214″ relative to a length of the arm 110.

FIGS. 5D and 5E show a straight retractor blade 203 in accordance withyet another embodiment of the present disclosure. The straight retractorblade 203 is substantially similar the angled retractor blade 202described above with regard to FIGS. 5A-5C, except that the planarportion 210″ and the blade portion 212′″ extend along transverse planesthat are orthogonal to each other, the protruding portion 214″ isaligned with the planar portion 210″, and a recess 213″ is defined in adistal end 212 a′″ of the blade portion 212′″.

As described above, the arm of a connector is configured and dimensionedto receive and support a protruding portion of a retractor blade. Asshown, for example, in FIG. 6A, the protruding portion 214 of theretractor blade 201 is received and supported in the 111 cavity, via thethird opening 111 c (FIG. 6B), of the arm 110 to releasably secure theretractor blade 201 to the arm 110. While the retractor blade showncoupled to the connector is a tapered retractor blade, it should beunderstood that the retractor blade may be a straight, tapered, orangled retractor blade, such as those shown and described above, amongother retractor blades within the purview of those skilled in the art.

As shown in FIG. 6B, the cavity 111 of the arm 110 houses a receivingelement 160. The receiving element 160 includes an engaging portion orfirst cavity 162 defined in a forked portion between opposed forks 164.The engaging portion 162 is configured and dimensioned to engage thegroove 216 of the protruding portion 214 of the retractor blade 201. Inembodiments, the engaging portion 162 includes a beveled edge. Theengaging portion 162 can slidably engage the groove 216 defined in theprotruding portion 214 to releasably secure the protruding portion 214of the retractor blade 201 to the arm 110.

The receiving element 160 includes a second cavity 166 configured anddimensioned to engage a spring 156 and a stop 158. The receiving element160 is biased towards a locked state by the spring 156. In the lockedstate, the length of the spring 156 is increased, e.g., at its longestlength, and the engaging portion 162 is engaged with the groove 216 ofthe protruding portion 214 of the retractor blade 201. The receivingelement 160 includes a third cavity 168 disposed between the first andsecond cavities 162, 166 that is configured and dimensioned to receive apost 170. The post 170 includes a body 172 and a head 174. The body 172of the post 170 is configured and dimensioned to extend through thesecond opening 111 b of the arm 110 and into the third cavity 168 of thereceiving element 160 such that the head 174 of the post 170 is adjacentthe front surface 118 b of the arm 110.

FIGS. 6C and 6D show the protruding portion 214 of the retractor blade201 engaged with the engaging portion 162 of the arm 110. The spring 156is positioned between the stop 158 and an inner wall 166 a of the secondcavity 166. The engaging portion 162 is engaged with the groove 216 ofthe protruding portion 214 of the retractor blade 201. As shown in FIGS.6E and 6F, in both of which the arm 110 has been removed for clearviewing of the receiving element 160, the forked portion of thereceiving element 160 (i.e., the space between forks 164) surrounds theprotruding portion 214 of the retractor blade 201 on two sides with theengaging portion 162 of the receiving element 160 engaged with thegroove 216 of the retractor blade 201. The post 170 is in closeproximity to the protruding portion 214 of the retractor blade 201because the spring 156 biases the receiving element 160 towards thelocked state (i.e., spring 156 extends towards its maximum length).

FIG. 6G and 6H show the engaging portion 162 of the receiving element160 disengaged from the protruding portion 214 of the retractor blade201. The post 170 is spaced from the protruding portion 214 of theretractor blade 201 by a distance greater than the distance therebetweenwhen the engaging portion 162 of the receiving element 160 is engagedwith the protruding portion 214 of the retractor blade 201 (see e.g.FIG. 6D). A user applies a force to the post 170, which causes thereceiving element 160 to compress the spring 156 (i.e., springcompresses towards its minimum length) and receiving element 160 movestowards an unlocked state. With the receiving element 160 in theunlocked state, the length of the spring 156 is shortened relative tothe length of the spring 156 when the receiving element 160 is in thelocked state because the post 170 acts on the spring 156, and theengaging portion 162 of the receiving element 160 is not engaged withthe groove 216 of the protruding portion 214 of the retractor blade 201.As shown in FIGS. 6I and 6J, in both of which the arm 110 has beenremoved for clear viewing of the receiving element 160, the forkedportion of the receiving element 160 surrounds the protruding portion214 of the retractor blade 201 on two side with the engaging portion 162of the receiving element 160 disengaged from the groove 216 of theretractor blade 201. The post 170 is separated by a distance from theprotruding portion 214 because the spring 156 is compressed and thereceiving element is in the unlocked state.

In a method of releasably coupling the retractor blade 201 with the arm110, the protruding portion 214 of the retractor blade 201 is pushedinto the cavity 111 of the arm 110 through the third opening 111 cdefined in the back surface 118 c of the arm 110. The protruding portion214 forces the engaging portion 162 of the receiving element 160 into anunlocked state (i.e., compressing spring 156) until the protrudingportion 214 extends out the cavity 111 through the second opening 111 bdefined in the front surface 118 b of the arm 110. At that moment, theengaging portion 162 enters the locked state (i.e., extending spring156) thereby releasably securing the protruding portion 214 of theretractor blade 201 within the cavity 111 of the arm 110.

Referring now to FIGS. 7A and 7B, there is shown a retractor or surgicalaccess system 1 in accordance with an embodiment of the presentdisclosure. The surgical access system 1 includes a plurality ofconnectors 100 (designated first and second connectors 100 a, 100 b), aplurality of supports 180 (designated first and second supports 180 a,180 b), and a beam 190. An arm 110 of the first connector 100 a iscoupled to the first support 180 a via a coupling element 120 of thefirst connector 100 a, and an arm 110 of the second connector 100 b iscoupled to the second support 180 b via a coupling element 120 of thesecond connector 100 b. The first support 180 a is coupled to the beam190 and the second support 180 b is slidably mounted on the beam 190such that the second support 180 b, and thus the arm 110 of the secondconnector 100 b, can be secured in a plurality of locations relative tothe first arm 110 of the first connector 100 a which is coupled to thefirst support 180 a.

In embodiments, the first and second connectors 100 a, 100 b are mirroropposite of each other. For example as shown in FIG. 7A, the couplingelement 120, the rod 130, and the ridged slider 140 of the firstconnector 100 a are reversed in location, i.e., mirror opposites, of thecoupling element 120, the rod 130, and the ridged slider 140 of thesecond connector 100 b. Such a configuration places the fixation pins150 (see e.g., FIG. 2B) of the first and second connectors 100 a, 100 bon lateral sides of the surgical access system 1 allowing the arms 110of the first and/or second connectors 100 a 100 b to be rotate about thefixation pins 150 between a closed or straight position as shown in FIG.7A (see also, e.g., FIGS. 2A and 2B), and an open or angled position asshown in FIG. 7B (see also, e.g., FIGS. 3A and 3B), or at any angletherebetween.

Retractor blades 200 (designated herein as first and second retractorblades 200 a and 200 b) may be releasably secured to the arms 110 of thefirst and/or second connectors 100 a, 100 b of the surgical accesssystem 1 as shown, for example, in FIGS. 8A-9B. While the retractorblades shown coupled to the connectors are straight retractor blades, itshould be understood that the retractor blades may be a straight,tapered, or angled retractor blade, such as those shown and describedabove, and combinations thereof.

The first and second retractor blades 200 a, 200 b are releasablycoupled to the arms 110 of the first and second connectors 100 a, 100 b,respectively, by engaging the protruding portion 214 of the first andsecond retractor blades 200 a, 200 b with the cavities 111 (FIGS. 7A and7B) of the arms 110, as described above. In FIGS. 8A and 8B, the firstand second connectors 100 a, 100 b are disposed in a straight or closedposition such that the planar portions 210 of the first and secondretractor blades 200 a, 200 b are aligned along the same plane and theblade portions 212 are substantially parallel to one another andsubstantially perpendicular to the beam 190. In FIGS. 9A and 9B, thefirst and second connectors 100 a, 100 b are disposed in an opened orangled position. In this configuration, the first and second retractorblades 200 a, 200 b are separated from one another by an angleddistance. In order to open or angle the arms 110 of the first and/orsecond connectors 100 a, 100 b, and the attached first and secondretractor blades 200 a, 200 b, a force is applied to the rods 130 of thefirst and second connectors 100 a 100 b, as described above, to rotatethe arms 110 about the respective fixation pins 150 of the first andsecond connectors, 100 a, 100 b. Additionally or alternatively, thearm(s) 110 may be grasped by a user and manually rotated. As seen inFIG. 8B, the first ends 130 a of the rods 130 are visible when theconnectors 100 a, 100 b are in the closed position and as seen in FIG.9B, the second ends 130 b of the rods 130 are visible when theconnectors 100 a, 100 b are in the open position. The arms 100,therefore, have been rotated about the fixation pins 150.

Also contemplated for use with the connector 100 and/or surgical accesssystem 1 of the present disclosure is an extension device 300, as shownin FIGS. 10A-10C. The extension device 300 includes a first extensionarm 302 having a plurality of projections 304 extending laterallytherefrom in spaced relation relative to each other, and a secondextension arm 306 also having a plurality of projections 304 extendingtherefrom. Each projection 304 defines a lumen 305 therethrough thatextends perpendicular to the projection 304.

The second extension arm 306 includes first and second ends 306 a, 306 aeach having a protruding portion 308 extending therefrom. Eachprotruding portion 308 includes a groove 310 defined therein thatengages with the engaging portion 162 of the receiving element 160 ofthe arm 110 of the connector 100. Accordingly, it should be understoodthat the protruding portions 308 of the extension device 300 isconfigured to slidingly engage the cavity 111 of the arm 110 and bereleasably secured thereto in substantially the same manner as discussedabove with regard to the protruding portion of a retractor blade.

The first extension arm 302 is connected to the second extension arm 306with a plurality of fixation pins 312 and a plurality of torsionalsprings 314 along the length of the first and second extension arms 302,306. Each of the plurality of projections 304 of the first extension arm302 is paired with a projection 304 of the second extension arm 306 toalign the lumens 305 of the projections 304. A torsional spring of theplurality of torsional springs 314 is positioned between the pairedprojections 304 and a fixation pin of the plurality of fixation pins 312is positioned through paired projections 304 and the torsional spring314.

Once the first and second extension arms 302 306 are coupled together, achannel 316 is defined therebetween. The second extension arm 306includes a receiving element 318 extending along the length thereof thatis disposed within the channel 316. The channel 316 is configured anddimensioned to releasably secure a plurality of retractor bladesthereto, and the receiving element 318 is configured to engage thegroove(s) of the protruding portion(s) of the retractor blade(s). Itshould be understood that the plurality of retractor blades may bestraight, tapered, angled, or combinations thereof, as described above.

The extension device 300 may be disposed in a closed position or an openposition. The torsional springs 314 bias the extension device 300 to theclosed position as shown in FIG. 10A. To open the extension device 300to the open position, a user applies a force to one or more of theplurality of projections 304 to force the first and second extensionarms 302, 306 to rotate about the fixation pins 312 to the openposition. Once the extension device 300 is open, the protrudingportion(s) of the retractor blade(s) can engage the channel 316.

Referring now to FIG. 11, a retractor or surgical access system 2 isshown including a plurality of extension devices 300 (designated firstand second extension devices 300 a, 300 b). The first and secondextension devices 300 a, 300 b are parallel to one another such thatthey are a mirror opposite of each other. The surgical access system 2also includes a plurality of retractor blades, including straight andangled retractor blades 200, 202. It should be understood that anynumber and combination of retractor blades may be used with theextension devices.

The angled retractor blades 202 are coupled to the first and second ends306 a, 306 b of the first and second extension devices 300 a, 300 b, andthe straight retractor blades 200 are coupled to the first and secondextension device 300 a, 300 b between the angled retractor blades 202about a central portion of the first and second extension devices 300 a,300 b. The area defined between the planar portions 210, 210″ of thestraight and angled retractor blades 200, 202 is substantially oval inshape which can increase the visualization of the surgical field, andminimize stress on the ends of an incision through which the retractorblades 200, 202 of the surgical access system 2 is introduced andplaced.

FIGS. 12A and 12B show a retractor or surgical access system 3 inaccordance with another embodiment of the present disclosure. Thesurgical access system 3 is substantially similar to the surgical accesssystem 2 of FIG. 11, but further includes a plurality of connectors 100(designated first and second connectors 100 a, 100 b), a plurality ofsupports 180 (designated first and second supports 180 a, 180 b), and abeam 190.

The second end 306 b of the first and second extension devices 300 a,300 b are releasably coupled to the first and second connectors 100 a,100 b, respectively, by inserting the protruding portion 308 of each ofthe first and second extension devices 300 a 300 b into the respectivecavity 111 of the arms 110 of each of the first and second connectors100 a, 100 b. The engaging portions 162 (see e.g., FIG. 6D) of therespective receiving element 160 of each of the arms 110 then engageswith a groove 310 on the respective protruding portion 308 of the firstand second extension devices 300 a 300 b, respectively. The first andsecond connectors 100 a, 100 b are coupled to the first and secondsupports 180 a, 180 b, respectively, with the first support 180 a fixedto the beam 190 and the second support 180 b slidably coupled to thebeam 190 such that the second support 180 b can be secured in aplurality of locations relative to the first support 180 a.

It is within the scope of the present disclosure that the plurality ofretractor blades 200, 202 are shown in a straight or closed positionbecause the first ends 130 a of the rods 130 of the first and secondconnectors 100 a, 100 b are visible and accordingly, the arms 110 of thefirst and second connectors 100 a, 100 b have not been rotated abouttheir respective fixation pins 150 (see e.g. FIG. 8B).

FIG. 13 shows a retractor or surgical access system 4 in accordance withyet another embodiment of the present disclosure. The surgical accesssystem 4 is substantially similar to the surgical access system 3 ofFIGS. 12A and 12B, but further includes third and fourth connectors 100c, 100 d, third and fourth supports 180 c, 180 d, and first and secondbeams 190 a, 190 b.

The first ends 306 a of the first and second extension devices 300 a,300 b are releasably coupled to the third and fourth connectors 100 c,100 d, respectively, by inserting the protruding portion 308 of each ofthe first and second extension devices 300 a 300 b into the respectivecavity 111 of the arms 110 of each of the third and fourth connectors100 c, 100 d. The engaging portions 162 (see e.g., FIG. 6D) of therespective receiving element 160 of each of the arms 110 then engageswith a groove 310 on the respective protruding portion 308 of the firstand second extension devices 300 a 300 b, respectively. The third andfourth connectors 100 c, 100 d are coupled to the third and fourthsupports 180 c, 180 d, respectively, with the fourth support 180 d fixedto the second beam 190 b and the third support 180 c slidably coupled tothe second beam 190 b such that the third support 180 c can be securedin a plurality of locations relative to the fourth support 180 d.

In embodiments, a user positions the straight and angled retractorblades 200, 202 within an incision of a surgical field. The userreleasably secures the protruding portion 214 of each retractor blade200, 202 into the channels 316 of the first or second extension device300 a, 300 b. In particular, the groove 216 of the protruding portion214 of each retractor blade 200, 202 engages the receiving element 318of the first or second extension device 300 a.

The protruding portions 308 of each of the first and second extensiondevices 300 a, 300 b is then releasably secured to the arms 110 ofrespective first, second, third, and fourth connectors 100 a-100 d. Theuser applies a force to insert the protruding portions 308 into thecavity 111 of the arms 110. As described above, the engaging portion 162of the receiving elements 160 of each of the respective arms 110 engagesthe groove 310 of the protruding portion 308 of each of the respectivefirst and second extension devices 300 a, 300 b.

Each arm 110 of the first, second, third, and fourth connectors 100a-100 d is connected to first, second, third, and fourth supports 180a-180 d, respectively, via the coupling element 120 of each of thefirst, second, third, and fourth connectors 100 a-100 d, as describedabove. The first and fourth supports 180 a, 180 d are fixed to the firstand second beams 190 a, 190 b, respectively, and the second and thirdsupports 180 b, 180 c are slidably mounted on the first and second beams190 a, 190 b, respectively.

It is contemplated that the extension devices and the secured retractorblades can be moved into an open or angled position when a user appliesa force to the rods of the connectors in a manner previously discussed.Additionally, it is contemplated that the extension devices and thesecured retractor blades can also be moved into a closed or straightposition when a user applies a force to the ridged sliders of theconnectors in a manner as also previously discussed.

Turning now to FIGS. 14A and 14B, a distractor device 400 is shown. Thedistractor device 400 includes first and second elongated members 410,420 connected together via a connection pin 430. The distractor device400 includes a proximal portion 400 a which forms a handle 440 of thedistractor device 400. The handle 440 is configured to allow a user toeffect movement of at least one of the first and second elongatedmembers 410, 420 relative to the other. In use, a force may be appliedto the handle 440 to cause the first and second elongated members 410,420 to move from a closed position, as shown in FIG. 14A, to an openposition, as discussed in further detail below. The handle 440 mayinclude a biasing mechanism 442 positioned between the first and secondelongated members 412, 422 in the proximal portion of the distractordevice 400 which biases the first and second elongated members 410, 420to the open or closed positions.

The distractor device 400 includes a central portion 400 b and thatextends along a longitudinal axis “X” (FIG. 16A) of the distractordevice 400, and a distal portion 400 c pivotably connected to thecentral portion 400 b.

Each of the first and second elongated members 410, 420 includes a flatportion 412, 422 on lateral sides of the distal portion 400 c, and apartial lumen 413, 423 extending substantially perpendicularly from theflat portions 412 422. The flat portions 412, 422 are substantiallyparallel to each other and abut each other when the distractor device400 is in a closed position. The partial lumens 413, 423 extend at leastpartially along a length of its corresponding first or second elongatedmember 410, 420.

While only the partial lumen 423 of the second elongated member 420 isshown in FIGS. 14A and 14B, it should be understood that the partiallumen 413 of the first elongated member 410 is identical thereto. Thepartial lumens 413, 423 include a plurality of detents 414, 424extending from an inner wall 416, 426 of the partial lumens 413, 423,respectively, in spaced relation relative to each other. In embodiments,the partial lumens 413, 423 include one or more detents 414, 424, insome embodiments, the partial lumens 413, 423 include two or moredetents 414, 424, and in certain embodiments, the partial lumens 413,423 include three or more detents 414, 424. Each detent of the pluralityof detents 414, 424 is configured and dimensioned to releasably secure aprotrusion 516 (see e.g., FIG. 15) of a pin 500, as described in furtherdetail below.

The detents 414, 424 are separated from each other by a ledge 418, 428extending along the inner wall 416, 426 of the partial lumens 413, 423.It should be understood that any number of detents 414, 424 and ledges418, 428 may be disposed in the partial lumens 413, 423 so long as theyare in an alternating pattern of, for example, detent, ledge, detent,ledge, and detent. In embodiments, the ledge 418, 428 is continuousalong the inner wall 416, 426 of the partial lumens 413, 423. In someembodiments, the ledge 418, 428 is non-continuous along the inner wall416, 426 of the partial lumens 413, 423.

The height of each detent 414, 424 from one ledge 418, 428 to anotherledge 418, 428 is variable and is based, in part, upon the height ofeach protrusion 516 (see e.g., FIG. 15) of a pin 500. At a minimum, theheight of a detent 414, 424 from one ledge 418, 428 to another ledge418, 428 is the same as the height of a protrusion 516 of a pin 500. Thedistance of a detent 414, 424 from one ledge 418, 428 to another ledge418, 428 should be at least sufficient to releasably secure theprotrusion 516 of the pin 500, and optionally a gap 517, which isdisposed above and/or below the protrusion 516. As specifically shown inFIG. 16E, the gap 517 of the pin 500 should be enough to ensure theprotrusion 516 is releasably secured within the detent 414, 424 of thefirst or second extensions arms 410, 420, and provide some additionalspace for small movements of the distractor device 400. However, the gap517 should not be so great as to allow the protrusion 517 to becomedislodged or separated from the detent 414, 424 and/or allow for largevertical movements of the distractor device 400 during use.

In embodiments, the distractor device 400, in its natural or biasedstate, is in the closed position. In the closed position, each of theflat portions 412, 422 of the first and second elongate members 410, 420are substantially parallel to, and abut, each other. When a force isapplied to the handle 440 (i.e., handle portions move towards eachother), the first and second elongated members 410, 420 move from theclosed position to the open position (i.e., away from each other). Inthe open position, the flat portions 412, 422 of the first and secondelongate members 410 420 remain parallel to each other but are separatedby a lateral distance. The separated distance can be increased byincreasing the force on the handle 440 of the distractor device 400.When the force on the handle 440 is released, the first and secondelongated members 410, 420 move toward each other to reduce theseparated distance until the first and second elongate members 410, 420return to the closed position, such as via the biasing mechanism 442which can force each of the first and second elongated members 410, 420towards each other (i.e., forces the first and second elongated members410, 420 to the closed position).

An exemplary pin 500 for use with the distractor device 400 is shown inFIG. 15. The pin 500 includes a proximal section 500 a, an intermediatesection 500 b, and a distal section 500 c. The proximal section 500 aincludes a shaft 510 at least partially cut with hexagonal facets 512along its length. The hexagonal facets 512 terminate at acircumferential groove 514. The circumferential 514 is located near aproximal end 500 d of the pin 500. The hexagon facets 512 and/or thecircumferential groove 514 can increase a friction fit with a device toinsert the pin 500 into a vertebral body.

The proximal and distal sections 500 a, 500 c are separated by theintermediate section 500 b. The intermediate section 500 b includes aplurality of protrusions 516 disposed in spaced relation relative toeach other. In embodiments, the intermediate section 500 b includes oneor more protrusions 516, in some embodiments, the intermediate section500 b includes two or more protrusions 516, and in certain embodiments,the intermediate section 500 b includes three or more protrusions 516.In embodiments, each protrusion of the plurality of protrusions 516 iscontinuous around the circumference of the pin 500. In some embodiments,the plurality of protrusions 516 are non-continuous around thecircumference of the pin 500.

The protrusions 516 are separated from each other by an interval 515.One of ordinary skill in the art can appreciate that any number ofprotrusions 516 and intervals 515 can be configured so long as they arein an alternating pattern of, for example, protrusion, interval, andprotrusion.

Each protrusion of the plurality of protrusions 516 is configured anddimensioned to releasably engage a detent 414, 424 on the distractordevice 400 (FIGS. 1A, 1B). It should be understand that the plurality ofprotrusions 516 can be any shape or in any pattern so long as they areconfigured to releasably secure the pin 500 to the plurality of detents414, 424 (FIG. 1A, 1B) of the distractor device 400.

The height of a protrusion 516 can vary and be based, in part, upon theheight of each detent 414, 424 of a distractor device 400. At a maximum,the height of a protrusion 516 is less than the height of a detent 414,424 so that the protrusion and the detent 414, 424 are snugly releasablysecured together. As shown in FIG. 16E, the height of the protrusion 516should be at least sufficient to releasably secure the protrusion 516,and optionally a gap 517 disposed above and/or below the protrusion 516.The gap 517 ensures the protrusion 516 is releasably secured within thedetent 414, 424 and provide some additional space for small movement ofthe distractor device 400. The gap(s) 517, however, should not be sogreat as to allow the protrusion 516 to become unsecured from the detent414, 424 and/or allow for large vertical movements of the distractordevice 400 during use.

The distal section 500 c of the pin 500 includes a first threadedportion 518 a and a second threaded section 518 b longitudinally spacedfrom each other and separated by a non-threaded gap 519. The secondthreaded section 518 b terminates at a threaded tapered distal end 500e. The gap 519 may be a visual marker for a user to measure the depth ofinsertion of the pin 500 into a vertebral body. In embodiments, thevisual marker may be in the form of a color, change of material, orchange in pattern. In embodiments, the pin 500 includes a plurality ofvisual markers. In some embodiments, each visual marker may be in theform of a color or a pattern. For example, a first pre-determined colormay indicate that the pin 500 is at a first depth into the vertebralbody, a second pre-determined color can indicate that the pin 500 is ata second depth into the vertebral body, and so on.

The pin 500 may have a length of from about 3 inches to about 4 inches.In embodiments, the pin 500 has a length from about 3.2 inches to about3.8 inches. In some embodiments, the pin 500 has a length of from about3.4 inches to about 3.6 inches, and in certain embodiments, the pin 500has a length of about 3.5 inches.

As shown in FIGS. 16A-16E, a surgical distraction system 5 includes adistractor device 400 and a plurality of pins 500. In a method of use,the pins 500 are placed in adjacent vertebral bodies, and the distractordevice 400 is positioned between the pins 500, as shown in FIG. 16A. Theplurality of detents 414, 424 of the first and second elongate members410, 420 are brought into contact with the plurality of protrusions 516of the pins 500 to releasably secure the distractor device 400 to thepins 500, as shown in FIGS. 16B-16E. A force can be applied to thehandle 440 of the distractor device 400 to move the first and secondelongated members 410, 420 of the distractor device 400 from a closedposition to an open position to assist in releasably securing theplurality of detents 414, 424 to the plurality of protrusions 516 of thepins 500.

After attaching the pins 500 to the distractor device 400, the pins 500are substantially parallel to one another and the distractor device 400is disposed in the closed position. The handle 440 of the distractordevice 400 may then be manipulated (e.g., by squeezing the first andsecond elongated members 410, 420 towards each other) to create aseparation between the first and second adjacent vertebral bodies.Squeezing the handle 440 applies a distraction force to the adjacentvertebral bodies by moving the pins 500, which remain substantiallyparallel to each other when in an open position, and thus the vertebralbodies away from each other and creating a space, or separation, betweenthe adjacent vertebral bodies. One or ordinary skill in the art willreadily understand the need for the pins 500 to remain substantiallyparallel to each other in a method for separating vertebral bodies.

An intervertebral disc located between the adjacent vertebral bodies maythen be removed. Once the intervertebral disc is removed, an implant canbe inserted. Thereafter, the handle 440 may be further manipulated toremove the distraction force, and the distractor device 400 may beremoved with the pins 500 from the adjacent vertebral bodies.

Referring now to FIGS. 17A-17C, a connector 600 in accordance withanother embodiment of the present disclosure is shown. The connector 600includes an arm 610, a coupling element 620, and a gear assembly 630having a first gear 632 and a second gear 634. The arm 610 is configuredand dimensioned to receive and support the second gear 634, and thecoupling element 620 is configured and dimensioned to receive andsupport the first gear 632. The coupling element 620 is coupled to thearm 610 with the first and second gears 632, 634 meshingly engaged witheach other such that rotation of the first gear 632 results in rotationof the second gear 634 which, in turn, pivots the arm 610 with respectto the coupling element 620, as will be described in detail hereinbelow.

The arm 610 includes a first end portion 610 a and a second end portion610 b. The second gear 634 is non-rotatably coupled to the first endportion 610 a of the arm 610, and the second end portion 610 b includesa cavity 611 defined therein. The cavity 611 is configured anddimensioned to house the receiving element 160 (see FIG. 6B) which, inturn, is configured and dimensioned to engage the protruding portion 214(see FIG. 6A) of the retractor blade 201, as described above. Similar tothe cavity 111 of the arm 110 of FIGS. 6A and 6B, the cavity 611 is openat a first opening (not shown) defined in a proximal surface 612 a ofthe arm 610, a second opening (not shown) defined in a front surface 612b of the arm 610, and a third opening 611 c defined in a back surface612 c of the arm 610.

The coupling element 620 includes a body portion 622 having a cavity 623defined therein that is configured and dimensioned to receive andsupport the first gear 632. An opening 625 of the cavity 623 is definedin a front surface 624 a of the coupling element 620, and a plate 626 issecured to a back surface 624 b of the coupling element 620 via afastener 627, such as a screw. Retaining features 628 extend from thebody portion 622 of the coupling element 620 for coupling with a support181 (see e.g., FIG. 18A).

The first gear 632 is in the form of a screw and includes a head portion636 a having a recessed end 637 configured to mate with a drivinginstrument (not shown) and an elongated threaded body portion 636 bterminating at a distal end 636 c. The recessed end 637 may be arecessed hex feature, e.g., hexagonal or hexolobular in shape, or anyother suitable configuration that is engageable with a suitable drivinginstrument to enable the driving instrument to control rotation of thefirst gear 632. The first gear 632 is rotatably disposed within thecavity 623 of the coupling element 620 such that the recessed end 637 ofthe head portion 636 a is accessible through the opening 625 of thecoupling element 620, and the distal end 636 c abuts an inner surface ofthe plate 626. In embodiments, the first gear 632 is a worm screw.

The second gear 634 is in the form of a wheel and includes a roundedbody portion 638 a having a toothed outer surface 638 b. The second gear634 is non-rotatably coupled to the first end portion 610 a of the arm110 such that the toothed outer surface 638 b meshingly engages theelongated threaded body portion 636 b of the first gear 632. It shouldbe understood that the toothed outer surface 638 b of the second gear634 has a pitch and shape to mate with the elongated threaded bodyportion 636 b of the first gear 632 allowing for fine angularadjustments of the arm 610 relative to the coupling element 620. Inembodiments, the second gear 634 is a worm wheel.

Turning now to FIGS. 18A and 18B, there is shown a retractor or surgicalaccess system 5 in accordance with an embodiment of the presentdisclosure. The surgical access system 5 includes a plurality ofconnectors 600 (designated first and second connectors 600 a, 600 b), aplurality of supports 181 (designated first and second supports 181 a,181 b), and a beam 190. The first connector 600 a is coupled to thefirst support 181 a via the coupling element 620 of the first connector600 a, and the second connector 600 b is coupled to the second support181 b via the coupling element 620 of the second connector 600 b. Thefirst support 181 a is coupled to the beam 190 and the second support181 b is slidably mounted on the beam 190 such that the second support181 b, and thus the second connector 600 b, can be secured in aplurality of locations relative to the first connector 600 a which iscoupled to the first support 181 a.

Retractor blades 201 (designated herein as first and second retractorblades 201 a, 201 b) may be releasably secured to the arms 610 of thefirst and second connectors 600 a, 600 b of the surgical access system5, as described above. While the retractor blades 201 shown coupled tothe connectors 600 are tapered retractor blades, it should be understoodthat the retractor blades may be a straight, tapered, and/or angledretractor blades, such as those shown and described above, among otherretractor blades within the purview of those skilled in the art.

The arm 610 of the first and/or second connector 600 a, 600 b may bepivoted relative to its respective coupling element 620 by inserting adriving instrument (not shown) into the recessed end 637 of the firstgear 632 to rotate the first gear 632 which causes rotation of thesecond gear 634 (FIG. 17B) and thus, the arm 610 relative to thecoupling element 620. The arms 610 may be rotated between a straightposition shown in FIGS. 18A and 18B, and an angled position shown inFIGS. 19A and 19B, among a variety of other angles. The first gear 632may be rotated in a first direction or a second direction to effectrotation of the arm 610 relative to the coupling element 620.

Referring now to FIGS. 20A-20C, a connector 700 in accordance withanother embodiment of the present disclosure is shown. The connector 700includes an arm 710, a coupling element 720, and a gear assembly 730having a first gear 732 and a second gear 734. The arm 710 supports thesecond gear 734 and the coupling element 720 is configured anddimensioned to receive and support the first gear 732. The couplingelement 720 is coupled to the arm 710 with the first and second gears732, 734 meshingly engaged with each other such that rotation of thefirst gear 732 results in rotation of the second gear 734 which, inturn, pivots the arm 710 with respect to the coupling element 720.

The arm 710 includes a first end portion 710 a and a second end portion710 b. The second gear 734 is non-rotatably secured to the first endportion 710 a of the arm 710. In embodiments, the second gear 734 isintegrally formed on the first end portion 710 a of the arm 710. Thesecond end portion 710 b of the arm 710 includes a cavity 711 definedtherein that is configured and dimensioned to house a receiving element760 (FIG. 20B). The cavity 711 is open at a first opening 711 a definedin a proximal surface 712 a of the arm 710, a second opening 711 bdefined in a front surface 712 b of the arm 710, and a third opening 711c defined in a back surface 712 c of the arm 710.

The receiving element 760 is substantially similar to receiving element160 and includes an engaging portion or first cavity 762 defined in aforked portion 764 of the receiving element 760, a second cavity 766configured and dimensioned to engage a spring 756 and a stop 758, and athird cavity 768 disposed between the first and second cavities 762, 766that is configured and dimensioned to receive a post 770. The engagingportion 762 engages the protruding portion 214 (see e.g., FIG. 23A) ofthe retractor blade 201 to releasably secure the retractor blade 201 tothe arm 710, as described above with respect to receiving element 160.

The coupling element 720 includes a body section 722 having a cavity 723defined therein that is configured and dimensioned to receive andsupport the first gear 732. First and second openings 725, 727 of thecavity 723 are defined in respective front and back surfaces 724 a, 724b of the coupling element 720, and a nut 726 is coupled to the firstgear 732 within the second opening 727 of the coupling element 720 toretain the first gear 732 within the cavity 723. The body section 722includes a first end portion 722 a including retaining features 728 forcoupling with a cross bar 740 (see e.g., FIG. 22A), and a second endportion 722 b including opposed openings 721 defined therethrough thatare configured to receive a fixation pin 750 for securing the couplingelement 720 to the arm 710.

The first gear 732 is in the form of a screw and includes a head portion736 a having a recessed end 737 configured to mate with a drivinginstrument (not shown), an elongated threaded body portion 736 b, and atail portion 736 c. The first gear 732 is disposed within the cavity 723of the coupling element 720 such that the recessed end 737 of the headportion 736 a is accessible through the first opening 725 of thecoupling element 720, and the tail portion 736 b is secured within thesecond opening 727 of the coupling element 720 via the nut 726 to allowthe first gear 732 to be rotated while being retained within the cavity723 of the coupling element 720. In embodiments, the first gear 732 is aworm screw.

The second gear 734 is in the form of a wheel and includes a roundedbody portion 738 a having a toothed outer surface 738 b. The second gear734 is non-rotatably coupled to the first end portion 710 a of the arm710 and, in embodiments, integrally formed therewith. The toothed outersurface 738 b of the second gear 734 is meshingly engaged with theelongated threaded body portion 736 b of the first gear 732. Inembodiments, the second gear 734 is a worm wheel.

The arm 710 of the connector 700 is movable relative to the couplingelement 720 from the straight position shown in FIGS. 20A-20C to angledpositions shown, for example, in FIGS. 21A and 21B. The arm 710 of theconnector 700 may be pivoted relative to the coupling element 720 abouta longitudinal axis “Y” of the coupling element 720 by inserting adriving instrument (not shown) into the recessed end 737 (see e.g., FIG.20B) of the first gear 732 to rotate the first gear 732 in a first orsecond direction which results in rotation of the second gear 734 andthus, the arm 710 relative to the coupling element 720. While two angledpositions are shown in FIGS. 21A and 21B, it should be understood thatthe gear assembly 730 provides for fine adjustment of the arm 710relative to the coupling element 720 about a range of angles.

Turning now to FIGS. 22A and 22B, the connector 700 may be releasablycoupled to a cross bar 740 via the retaining features 728 of thecoupling element 720. The retaining features 728 of the coupling element720 are configured to mate with retaining features 742 of the cross bar740. In embodiments, the retaining features 728 of the coupling elementinclude a protrusion 728 a and a hook 728 b configured to engage arecess 742 a and a slot 742 b of the retaining features 742 of the crossbar 740 to releasably secure the connector 700 to the cross bar 740.

The connector 700 and the cross bar 740 may be part of a surgical accesssystem 6 as shown in FIGS. 23A and 23B. The surgical access system 6includes a plurality of connectors 700 (designated first and secondconnectors 700 a, 700 b), a plurality of supports 181 (designated firstand second supports 181 a, 181 b), and a cross bar 740 interconnectingthe first and second supports 181 a, 181 b. The coupling elements 720 ofthe first and second connectors 700 a, 700 b are coupled to the crossbar 740 as shown, for example, in FIGS. 22A and 22B. The first andsecond supports 181 a, 181 b may further be coupled to respective beams190 (see e.g., FIG. 18A), as described above.

Retractor blades 201 (designated herein as first and second retractorblades 201 a, 201 b) may be releasably secured to the arms 710 of thefirst and/or second connectors 700 a, 700 b of the surgical accesssystem 6. While the retractor blades 201 shown coupled to the connectors700 are tapered retractor blades, it should be understood that theretractor blades may be a straight, tapered, and/or angled retractorblades, such as those shown and described above, among other retractorblades within the purview of those skilled in the art.

The arm 710 of the first and/or second connectors 700 a, 700 b may berotated relative to its respective coupling element 720 by inserting adriving instrument (not shown) into the recessed end 737 of the firstgear 732 (see FIG. 20B) to rotate the first gear 732 which causesrotation of the second gear 734 and thus, the arm 710 relative to thecoupling element 720. The arm(s) 710 may be rotated between a straightposition shown in FIGS. 23A and 23B, and an angled position shown inFIGS. 24A and 24B, among a variety of other angles as described above.

Persons skilled in the art will understand that the structures andmethods specifically described herein and shown in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merely asexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. Additionally, the elements and features shownand described in connection with certain embodiments may be combinedwith the elements and features of certain other embodiments withoutdeparting from the scope of the present disclosure, and that suchmodifications and variation are also included within the scope of thepresent disclosure. Accordingly, the subject matter of the presentdisclosure is not limited by what has been particularly shown anddescribed.

What is claimed is:
 1. A surgical access system comprising: a beam; afirst support operably coupled to the beam; and a first connectoroperably connected to the first support, the first connector including:an arm including a first end portion and a second end portion; acoupling element including a body portion defining a cavity therein; anda gear assembly including a first gear disposed within the cavity of thecoupling element and a second gear non-rotatably disposed at the firstend portion of the arm, the first and second gears meshingly engagedwith each other such that rotation of the first gear results in rotationof the second gear which, in turn, causes the arm to pivot with respectto the coupling element.
 2. The surgical access system according toclaim 1, wherein the first gear includes a head portion and an elongatedthreaded body portion terminating at a distal end.
 3. The surgicalaccess system according to claim 2, wherein an opening of the cavity isdefined in a front surface of the coupling element, and the head portionof the first gear is accessible through the opening for rotating thefirst gear.
 4. The surgical access system according to claim 2, whereinthe first gear is a worm screw.
 5. The surgical access system accordingto claim 1, wherein the second gear includes a rounded body portionhaving a toothed outer surface.
 6. The surgical access system accordingto claim 5, wherein the second gear is a worm wheel.
 7. The surgicalaccess system according to claim 1, wherein the second end portion ofthe arm includes a cavity having a receiving element disposed therein,the receiving element including an engaging portion movable between alocked state and an unlocked state.
 8. The surgical access systemaccording to claim 7, further including: a first retractor bladeincluding: a planar portion including a protruding portion having agrooved defined therein, the protruding portion releasably engaged withthe engaging portion of the receiving element; and a blade portion, theplanar and blade portions extending along different planes.
 9. Thesurgical access device according to claim 8, further including: a secondsupport operably coupled to the beam; a second connector operablyconnected to the second support; and a second retractor blade releasablyengaged to the second connector.
 10. A surgical access systemcomprising: a first support; a second support; a cross barinterconnecting the first and second supports; and a first connectoroperably connected to the cross bar, the first connector including: anarm including a first end portion and a second end portion; a couplingelement including a body portion defining a cavity therein; and a gearassembly including a first gear disposed within the cavity of thecoupling element and a second gear non-rotatably disposed at the firstend portion of the arm, the first and second gears meshingly engagedwith each other such that rotation of the first gear results in rotationof the second gear which, in turn, causes the arm to pivot with respectto the coupling element.
 11. The surgical access system according toclaim 10, wherein the first gear includes a head portion, an elongatedthreaded body portion, and a tail portion.
 12. The surgical accesssystem according to claim 11, wherein a first opening of the cavity isdefined in a front surface of the coupling element, and the head portionof the first gear is accessible through the first opening for rotatingthe first gear.
 13. The surgical access system according to claim 11,wherein the first gear is a worm screw.
 14. The surgical access systemaccording to claim 10, wherein the second gear includes a rounded bodyportion having a toothed outer surface.
 15. The surgical access systemaccording to claim 14, wherein the second gear is a worm wheel.
 16. Thesurgical access system according to claim 10, wherein the second gear isintegrally formed on the first end portion of the arm.
 17. The surgicalaccess system according to claim 10, wherein the second end portion ofthe arm includes a cavity having a receiving element disposed therein,the receiving element including an engaging portion movable between alocked state and an unlocked state.
 18. The surgical access systemaccording to claim 17, further including: a first retractor bladeincluding: a planar portion including a protruding portion having agrooved defined therein, the protruding portion releasably engaged withthe engaging portion of the receiving element; and a blade portion, theplanar and blade portions extending along different planes.
 19. Thesurgical access device according to claim 18, further including a secondconnector operably connected to the cross bar.